NPIMap

Organization Active NPI

Kalista Wellness Center LLC

  • Naturopath
  • Medford, OR
National Provider Identifier
1679937312
Registry record updated Aug 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
NaturopathTaxonomy code 175F00000X
Legal business name
KALISTA WELLNESS CENTER LLC
Practice address
18 Myrtle St
Medford, OR 97504-7471
Phone
(541) 779-0100
Fax
(541) 779-0107
NPI assigned
Apr 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Wendy Penelope Green, N.D.NPI 1225227002
Title
Owner / Doctor
Phone
(541) 779-0100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
NaturopathGroup: 193400000X SINGLE SPECIALTY GROUP 175F00000X Primary

Addresses

Primary practice location

18 Myrtle St
Medford, OR 97504-7471

Mailing address

18 Myrtle St
Medford, OR 97504-7471
Phone (541) 779-0100

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501632000000",
    "number": "1679937312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 MYRTLE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047471",
            "telephone_number": "541-779-0100",
            "fax_number": "541-779-0107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 MYRTLE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047471",
            "telephone_number": "541-779-0100",
            "fax_number": "541-779-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALISTA WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-08",
        "last_updated": "2017-08-02",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "PENELOPE",
        "authorized_official_title_or_position": "OWNER / DOCTOR",
        "authorized_official_telephone_number": "541-779-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "N.D."
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Naturopath",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.